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Transcript: Mayor de Blasio Announces Plan to Guarantee Health Care for All New Yorkers

January 8, 2019

Mayor Bill de Blasio: Mina, thank you. First of all, it takes courage to tell your own story and I can only imagine how difficult that time was. But I want to just tell you, I really admire you for taking everything you went through, all that challenge, all that pain and then deciding you were going to turn it around and help other people. And every single person who you got on to health insurance through GetCoveredNYC – your own efforts – you're making sure that people have the care they need when they need it.

I really admire you for what you've done. Less thank Mina, everybody.

[Applause]

This is why we need to guarantee health care for all New Yorkers – it’s as simple as that, because no one should have to live in fear. No one should go without the health care they need. Health care is a human right. In this city, we're going to make that a reality. In this city, we're taking that ideal and putting it into practice. From this moment on in New York City, everyone is guaranteed the right to health care – everyone.

[Applause]

We are saying the word guarantee because we can make it happen because of the great professionals you see behind me here at Lincoln Center and at facilities all – Lincoln Center, excuse me – Lincoln Hospital. Lincoln Center's good too.

[Laughter]

Here at Lincoln Hospital. All of these professionals and other great New Yorkers like them are going to be in the frontline of this new effort. And I want to say, I've been at Lincoln hospital a bunch of times. It's a home away from home. I really admire what all of you are doing. Everyone give your neighbor a round applause. Thank you for all that you do.

[Applause]

For too many New Yorkers – they live in fear. They live in fear of getting sick. They don't know where to turn. They don't know how they're going to afford health care. About 600,000 New Yorkers do not have any health care coverage at all – that's as many people as live in the entire city of Milwaukee or the entire city of Baltimore. 600,000 people with nowhere to turn, except the emergency room, which is exactly the last place we want to see people go.

Today, we take a huge step forward because we're telling people it's guaranteed. That's going to change people's lives and it's going to change the way they act, because when you know something is guaranteed, you act differently, you behave differently. You now know it's there for you. It's meant to be there for you. It's not something you have to fight for or struggle for. It's not some maze you have to complete. It's guaranteed. It will be accessible. It will be available. The idea is no one should have to wonder. And I can say – you know, as you'll hear from Chirlane in a moment – but when we were young parents in particular, we spent a lot of time trying to figure out where to get our kids, what they needed. When we were older parents, we spent a lot of time trying to figure out how to get services for our children that we did not know how to navigate. And there's lots and lots of New Yorkers who are in a much, much tougher situation than we were in.

What we know is, if people don't know they have a right to something, they're going to think it's not for them. They're going to think there's nowhere to turn there. You know what? You know how many people in this city every single day know they're sick, and they don't have a doctor they can turn to, and they don't have enough money in their pocket, so they just go off to work sick and they get sicker, and it ends so often in an emergency room – a situation that could have been prevented so easily if people just knew there was a place to turn.

When this plan is fully implemented, every New Yorker who needs a doctor will have an actual doctor with a name and a place. They're going to have a card that will empower them to go to that doctor whenever they need – a primary care doctor, an actual person that you can turn to that’s your doctor, and the specialty services that will make all the difference, whether it's maternity or – let me do it again, GYN care – whether it is mental health care – and you'll hear from the First Lady in the moment – which has been so hard for people to access for so many years. Pediatric Care, you name it – the things that people need will be available to them and this has got to be a difference maker in their lives. The message will be, go get the health care you need when you need it. Don't wait. Don't feel it's not for you. Don't feel you can't afford it. Get the health care you need when you need it. You won't end up in the emergency room. You own end up in a hospital bed if you actually get the care you need when a disease starts, not when it's already too late. So that's what we're here to achieve.

This is built on a series of actions that were taken the last few years, obviously what's been done to strengthen Health + Hospitals. Again, want to thank everyone behind me for their extraordinary work. Obviously you're going to hear from Dr. Mitch Katz in a moment – want to commend his predecessor, Stan Brezenoff as well. And you're going to hear from Dr. Herminia Palacio. I want to commend her. All the people who work so hard with the folks in HR facilities to turn Health + Hospitals around – this plan today wouldn't be possible if that hard work was not done over the last few years to bring Health + Hospitals back from the brink and allow it to now get to the work of providing high-quality care all over the City.

Obviously you're going to hear from the First Lady about Thrive and another crucial initiative, Healing NYC, that contributed to building the kind of framework where we could get care to people when they need it. And because of GetCovered NYC, 130,000 people got health insurance through the exchange who wouldn't have if there wasn't such an expensive outreach effort and effective outreach effort. I want to commend all of your colleagues also, Mina, for their amazing efforts. All of these pieces have helped us to get to the launching pad that we can now go this last step, this last mile to get health care to everyone.

So look, you might say right at the jump, is this something that ideally should be handled in Washington D.C. or an Albany? Yes, it should. Let me just make that clear at the outset. The solution, the ultimate solution is single-payer health insurance for this whole country or Medicare for All. That's the ideal. That's what we need.

[Applause]

And I strongly support a single-payer bill that's going to be a considered in Albany this spring, because if Washington won't act, then our State government should act. But you know what? We don't wait here in New York City. We don't wait. We're not going to fall for the trick of hanging around waiting for Washington D.C to solve our problems. We're going to solve our own problems in the meantime and we're going to work for those bigger changes. But our people need health care right now. They need it right now and we can get it to them. And I think by New York City acting, the biggest city in country acting is actually going to create momentum for those bigger changes, because people all over the state, all over the country are going to see – you know what? Universal health care really should be the goal and we all need to get to work to make it happen.

I would note one more point about Washington, in the last couple of years, there's been tremendous focus, tremendous energy, pinpoint precision in Washington among Republicans trying to reduce the amount of health care people get, trying to take away the right to health care, trying to water down Obamacare and debilitate it. Lots of time and energy has been put into taking away health care from tens of millions of people. What we're doing here in New York City, we're getting health care to a lot of people never had it before. We're going the opposite direction. We’re going to get it to everyone.

So as this discussion has ensued, and I want to thank all of the people who had been a part of it, I mentioned several of them, but I also want to thank Dr. Oxiris Barbot, our Health Commissioner; our Commissioner for the Mayor's Office of Immigrant Affairs Bitta Mostofi; our OMB Director will be with us here shortly, Melanie Hartzog; a lot of advocates who have fought for this type of idea and will be fighting in Albany and Washington, the New York State Nurses Association and make the Road New York.

[Applause]

The New York Immigration coalition; and of course, Planned Parenthood in NYC – all of these organizations have been fighting for health care for all. When I asked my team, what is it going to take? I said to them, here's the idea – universal health care. Everyone gets served, guaranteed health care for every New Yorker – what's that going to take? And it has to come with a clear ability of every New Yorker to get to an individual doctor that is their own, a primary care doctor that they will know by name and will be there for them. What's it going to take? And this plan, NYC care – this plan we announced today will achieve that goal, we'll achieve that vision. It has been years in the making, but we're finally ready to ensure that every single person gets served.

I'll conclude by saying this – when you think about the people out there, the 600,000 people out there who have no coverage at this moment, they're all different kinds of New Yorkers. Some of them are young, and, as Mina said, they think maybe they don't need insurance. Well, I'm here to tell them, everyone needs coverage. Everyone needs a place to turn. Some folks just can't afford the policies that are on the exchange. Some people can't navigate the system, they find it overwhelming. Some folks are our neighbors who happen to be undocumented. What are they all have in common? They need coverage. They need health care. And we know this is the approach – we take the public option that is MetroPlus, we build it out, we strengthen it, we get it to more and more people, and we take the strength of our public health system and we make it easier to use, and we make it user friendly, and we make it accessible, and we give everyone that doctor by name, and we changed the whole way people get health care.

NYC Care is going to make a difference. For those who can afford something, they'll pay on a sliding scale. For those who can't afford anything, care will be for free. No one will be turned away and care will be comprehensive. That is what we believe in, in New York City. Those are New York City values. No one gets turned away. Everyone is respected.

[Applause]

So I've been talking over this last year or two about our goal of being the fairest big city in America. I can safely say guaranteeing health care for all New Yorkers is one of the big steps to becoming the fairest big city in America, and we're going to do it. We're going to do it, everyone.

[Applause]

A few words in Spanish –

[Mayor de Blasio speaks in Spanish]

Medical care is a human right. Health care is a human right.

[Applause]

Now, the idea of being comprehensive would never work if it was just about physical health care. It only works if we include mental health care. One in five Americans, one in five New Yorkers deal with a mental health challenge every single day. And the reason in this city we are talking about mental health care in the same sentence with physical health care, the reason we have parity in everything we do, including the initiative that we announced today, is because our First Lady fought from day one to end the stigma to make sure everyone got the care they needed.

My pleasure to introduce Chirlane McCray –

[Applause]

First Lady Chirlane McCray: Thank you, Bill. And thank you, Mina, for sharing your powerful story. It means so much to the people that you serve, that you're able to speak with them as a peer and to share the importance of this coverage that everyone needs.

You know, my parents used to say that if you had your health, you've got everything. You know, it all begins with being healthy. And I've added to that – well, if you have your health and your mental health, then you really can go on and do anything.

For more than three years, ThriveNYC has worked to tear down the barriers to mental health care. We've taken on stigma, we've expanded access to mental health care services in our schools and our neighborhoods. We have made it easier than ever to make an appointment with a counselor or a therapist through NYC Well. But for the 600,000 New Yorkers without any kind of insurance, mental health care remains out of reach.

This year, we changed that for good. Guaranteed health care means guaranteed mental health care. There is no such thing as comprehensive care without mental health and substance-use services. When New Yorkers enroll in NYC Care, they will be set up with a primary care doctor who can refer them to the many behavioral health services offered by Health + Hospitals. They can receive services for alcohol and other substance misuse. They can get buprenorphine treatment for opioid addiction. Psychiatric and regular therapy sessions are also included. Of course, many people living with mental illness have no idea they have a mental health condition that can be treated, but their primary care doctors can help assess their symptoms and determine what is best for them because they'll be supported along the way by ThriveNYC is Mental Health Service Corps.

The Corps is made up of recently graduated masters and doctoral level clinicians who are placed in substance-use programs, mental health clinics, and primary care practices throughout the five boroughs. Corps members often come from the communities that they serve. They speak many languages, represent the cultural and ethnic backgrounds of New York City. They serve where they can do the most good in the highest need communities. Currently, nearly 50 Corps members proudly serve at 37 Health + Hospital sites across the city. From supporting the primary care doctors and assessing mental health needs, to providing therapy – providing a treatment, like therapy. Members of the Mental Health Service Corps will be essential in extending comprehensive coverage to every New Yorker, and they will continue to make mental health care in our city more accessible, inclusive, and culturally competent.

What today's announcement, New York City is taking yet another leap ahead of the rest of the nation in mental health. No other city or state provides this level of care to all residents, and that is our goal – to make sure everyone has the care they need when and wherever they need it.

Now, a few words in Spanish

[First Lady McCray speaks in Spanish]

Thank you.

Mayor: I want to emphasize in English the last point that's Chirlane made in Spanish – when this is fully implemented, it will be the most comprehensive health system in the nation. It literally means all 8.6 million people will have some form of coverage and will have access to health care, both physical and mental health care. There's no place in the country that has yet reached that goal. We will reach it here and it makes us very proud as New Yorkers.

Now, this wouldn't have been possible, as I said earlier, without extraordinary efforts to revitalize Health + Hospitals. And that was a very lofty goal some years ago, but a Dr. Herminia Palacio believed it could be done. She had great partners that she brought in to help achieve this goal. And we put the time and the energy and the resources into it, and it is all bearing fruit now. And I know she is proud of that and she's especially proud to be back in her native Bronx – our Deputy Mayor, Dr. Herminia Palacio.

[Applause]

Deputy Mayor Herminia Palacio, Health and Human Services: Thank you so much, Mr. Mayor, for leading this charge to make health care for all a reality in New York City. Thank you, Mina, for sharing your story. And I am so excited to be here not just in the Bronx but to be here in New York City in this administration for today’s announcement of NYC Care which is our commitment to guaranteeing health care for all New Yorkers.

As a physician I know how vital health care coverage is, and facilitating the use of primary care and preventive care. We’ve made incredible strides already here in New York City in connecting New Yorkers to health insurance. As the Mayor mentioned nearly eight million New Yorkers already have health insurance thanks to the Affordable Care Act.

And thanks to people like Mina and initiatives like GetCoveredNYC, the uninsured rate in New York City is nearly half what it was in 2013. However, even with these great efforts there are those among us who live without health insurance because they can’t get it or can’t afford it. And NYC Care is here to help us keep our city healthy and to guarantee comprehensive – comprehensive care for all.

We will boost our efforts to link eligible New Yorkers to MetroPlus. We will connect those without health insurance or who can’t afford health insurance to Health + Hospitals for high-quality coordinated care because it’s not just about having health insurance, it’s knowing where you can go for care, it’s feeling welcome when you get to care, it’s being treated with dignity when you walk through the walls, it’s being treated with – in the languages that you understand, with the sensitivity of people who actually care about your well-being. It’s about guaranteed care.

So, as Deputy Mayor for Health and Human Services I am delighted to be here and to help make New York City the healthiest place to live. A few words in Spanish –

[Deputy Mayor Palacio speaks in Spanish]

[Applause]

Mayor: Thank you very much. Now, I’m going to turn to Dr. Mitch Katz, the President and CEO of Health + Hospitals – and he’s done extraordinary work in his time here deepening the transformation of Health + Hospitals, giving it the potential now to lead in a new initiative like this. Health + Hospitals will be key to our effort to guarantee health care for all New Yorkers. I also want to say that the work he did previously first in San Francisco then in Los Angeles provides the groundwork for what we are announcing today. Those two cities did very important steps in providing health care to more people. The difference here is we’re going to provide health care to all people and a very comprehensive list of services. So, we’re building on his great work previously and taking it to the next level here in this city. Dr. Mitch Katz –

[Applause]

President and CEO Mitchell Katz, NYC Health + Hospitals: Thank you, Mr. Mayor and I feel so lucky to work for you, to work for a mayor who makes sure that guaranteed health care is available to all.

I also feel so lucky to have as colleagues the doctors and nurses and physician assistants and social workers and pharmacists and all the people who make Lincoln Hospital great. I think it’s very significant, Sir, that you chose to do this at Lincoln Hospital. First, Lincoln Hospital is among the ten busiest emergency rooms in the United States – not in New York, in the United States.

[Applause]

That’s because there’s not enough availability and guarantee of primary care, of health care that people can get of coverage – and you’ve made sure that going forward, people will now be able to have their own doctor and be able to be seen in primary care and only come to the emergency room when that’s the level of care they need. The other reason I think it’s so significant that you chose Lincoln Hospital is Lincoln Hospital is a place where the doctors took over the hospital. They pushed out administration, they ran the hospital, so what was their demand? Were they demanding more pay? No. Were they demanding better working conditions? No. They were demanding better services for the people who lived in the South Bronx and they were angry at the fact that the City was not providing the services –

[Applause]

That the people here needed –

Mayor: Mitch, it’s a beautiful analogy but you have to tell them when it happened.

[Laughter]

President and CEO Katz: A while ago.

[Laughter]

Mayor: A long while ago.

President and CEO Katz: But you are –

Mayor: It took a little while – I think it was the 1970s, if I remember correct.

[Laughter]

I took a little while for the dream to come true but now the dream of those professionals is coming true.

President and CEO Katz: But it’s here and so, I’m just very proud to be part of it. Thank you so much, Sir.

Mayor: Thank you, Dr. Mitch Katz.

[Applause]

For that inspiring yet confusing story.

[Laughter]

Thank you. Alright, to our friends in the media – we are going to open up to questions on NYC Care and then after that we’ll give people a chance to go back to other things they have to do and we’ll take other topics as well. Yes, David.

Question: A couple questions – practically, you mentioned there’s going to be a card and everyone will have their own doctor. What are the wait times you’re anticipating and how will the card work and –

Mayor: Okay, slow down. We’ll do them all.

Question: I have another question.

Mayor: We’ll get to all of it but let’s start at the very beginning – the card and what it achieves and then we’ll talk about the wait. So, Herminia, Mitch – who wants to explain the vision and again it will start immediately, it will be fully implemented over the next few years. Explain the vision.

Deputy Mayor Palacio: So, I’ll begin. The vision is really for this card to be a membership card. It’s a membership card for the services at Health + Hospitals. It’s around building on the work that Dr. Katz has already done to shorten wait times to primary care, and I’ll let him expand. It’s about being able to have – for people to be able to have a number that they can call to get actual solutions to the problems that they need.

President and CEO Katz: Right now the wait time for a primary care appointment is within a week we could get somebody a primary care appointment, and the commitment of this administration is as more and more people join this program, we will maintain that – within a week or two weeks, everyone will have access to a primary care doctor.

Question: I wanted to ask the price tag that you had said in additional spending for this program is $100 million. Now there was a program – a pilot program that was done to try and cover just undocumented, uninsured New Yorkers and that cost about $6 million over the course of a year and it covered 1,300 New Yorkers so that’s a cost of about $4,500 per undocumented person, or if you could expand it to [inaudible] that would be $1.4 billion –

Mayor: Yeah, fair question –

Question: [Inaudible]

Mayor: Because that was a very small pilot with a whole different concept. This is about a whole guaranteed approach for all New Yorkers and so it changes the economy as a scale and it changes the whole approach. We recognize over time that we had to find a way to get the health care for everyone. And again, we saw almost two equal sized pools of people – folks who were eligible for insurance but weren’t getting it for whatever reason, and folks who are undocumented. We wanted one large solution for everyone. And we believe that this is going to be possible for several reasons – and I’ll turn to my colleagues to articulate more – but for one thing we’re spending a lot of money right now and we’re not spending it the way we want to because people go to the emergency room and so – yes, everyone was applauding because it is a measure of their professionalism that they can handle serving people in one of the ten toughest emergency rooms in the nation.

That’s something to applaud, but everyone behind me wishes people were not getting their first care at the emergency room, right? Which is incredibly inefficient and costly. Also, a number of hospitalizations are caused because people didn’t get care earlier and better. So, we’re talking about a vast amount of the cost that we can avert if we had a system that actually universally provided care. And I think the pre-K analogy is really important here.

It’s one thing – we’re glad we tried the pilot but again we realized along the way we needed a much bigger, more comprehensive solution. There’s a big difference when people know maybe they’ll get something versus it is guaranteed. The minute something is guaranteed, people respond the guarantee. When they hear more and more people around them, when they see more and more evidence that guarantee it’s working the pick up on it which means more and more people will see, ‘Hey, my neighbor got a primary care doctor, I never had a doctor but now my neighbor goes to Dr. Jones, and Dr. Jones is five blocks away and this is working. I want that too.’ And more and more people will pick up on it.

So, you have a lot of savings over time by not having people get health care the wrong way. That’s the first part of the answer. You guys want to add?

Deputy Mayor Palacio: Yes, I’m – specifically on your question, that was a pilot program that had a large research arm. This is really about delivering care not about doing the research. So, we’ve incorporated some of the valuable lessons into the development of the program. This is about delivering care, building on the success of the transformation and the stabilization of Health + Hospitals’ finances, building on the success of our efforts and understanding around the ACA – so this is really connecting all of those threads and building upon it to guarantee care for that remaining bucket of people who don’t gave either insurance or can’t afford insurance.

Question: [Inaudible] cover so many people.

President and CEO Katz: Remember that the cost of the expensive part of health care is hospitalization – expensive radiologic tests. Because we have an existing system, those costs are already in the system. What needs to be in the system is primary care, preventive care. Those things cost less but they yield huge benefits over time.

Mayor: So, we can – we’ll get you some specific models to see but I think the point is there’s a kind of smoothing – I’m not a doctor and I’m not a [inaudible] but I can put it into simple terms – there’s a smoothing that occurs when you take a group of people who are getting very expensive care much later than they should and that is a huge burden on the health care system. Instead you get those people earlier ,better care, avert emergency room visits, avert hospitalizations.

You can serve a lot more people if you can serve them more effectively and efficiently on the front end. That’s a key to why this is possible. Another key, David, is the – Health + Hospitals has been a whole process of renewal and can provide a much more efficient product. And that’s another reason why we think we can get a lot more done with the resources we have and these additional resources. Go ahead.

Question: I just wanted to see if – and maybe this is for Dr. Katz – just the wait times, when you testified earlier this year at the City Council, you said that people with MetroPlus for the first primary care appointment, the average wait was three months and for specialties it was four to six months. And I guess I want to see if it changes drastically as you suggest but also what impact is – I mean, 600,000 might not all come at once but –

Mayor: Yes, they will not all show up on one say, I assure you.

Question: How is that going to impact the wait times? I guess are there enough physicians and other hospital staff to take care [inaudible]?

President and CEO Katz: Yes, the situation has changed dramatically. When I testified to that, that was true at that time and in part because of the efforts of the Mayor and Dr. Palacio even before I got here to transform the outpatient system. We have hired a large number of primary care doctors and that’s why I can tell you with confidence that right now the waiting time – within a week or two weeks – we can guarantee someone a primary care appointment.

Question: [Inaudible] specialty care?

President and CEO Katz: Specialty care has improved. There’s more distance for that to go but by the time we – people are enrolling in the summer, it will be markedly shorter.

Question: [Inaudible] two questions. The first one has to do with the costs and obviously [inaudible] City budget but my question is – are there any estimates to how much you’ll actually save by having people have primary care physicians as opposed to going to the ER where it’s exponentially more expensive?

Mayor: Absolutely, Marcia, so again, we’ll get people some of the break outs later in the day but I want to give the basic point of how we’re able to achieve this with an additional $100 million a year as it eventually builds out. It is because there is a lot of money right now in our health system that can be used a lot better. And again if you think about – I’ll try and make it, use a good analogy here. If you think about an individual who goes to that primary care doctor, the doctor says you have a problem, you need some help. You go get the help – and Mitch, you can use the example of a Pap smear and describe it because you made that powerful point the other day. You get the help on a timely basis, you don’t end up in a situation where you now have an advanced disease that requires prolonged hospitalization.

We all know how bad that is for people but also how expensive that is for our health care system. Obviously, any time you’re seeing a primary care doctor or a specialist and you’re getting your issue addressed, that’s immensely better and cheaper than going to an emergency room and a much better experience. So some of this again is that a lot of money is being spent right now in a very inefficient manner because tragically our health care system got built around a lot of people not being insured and the emergency room being the default place to get health care. We want to flip the script, we want to get everyone covered in one form another, the emergency room truly should become a last resort. Would you give that example on the –

President and CEO Katz: Absolutely, I know that if someone came to our trauma center, they would get amazing care. What I want to make sure of is that a young woman who needs a pap smear gets a pap smear in a timely way and that’s why primarily care is so important. Cervical cancer is 100 percent a preventable disease by getting regular pap smears and getting any treatment, if undetected, cervical cancer is one of the most horrible ways to die so we have something we have simple test, preventative, that’s what our focus should be.

Mayor: And just to help point out, I don’t know the answer but I assume one of you two might, how, what’s that percentage of women who don’t get a pap smear so that we have some frame of reference here of how many more people we would like to serve. Do you have a sense of that?

Deputy Mayor Palacio: We can get that to you.

Mayor: Okay, I think that would be helpful, yes? Okay go ahead.

Question: Another question having to do with the politics of this – you pointedly said that it should be being done in Washington and in Albany –

Mayor: Yes.

Question: So I wonder, you know, does this furnished your liberal credentials, the city’s liberal credentials and does it put pressure at least on Albany if not Washington to do something like this?

Mayor: It puts pressure on Albany for sure, for action. But you know, the reason we are doing it is to serve the people of New York City, I mean let’s start at the beginning, if this issue had been addressed already, we wouldn’t have to take this action. The discussion in our country of the need for a national health care plan began with Harry Truman in the 1940’s and we are still not there. In fact in 2017 we took a step backwards when the Republican Congress voted to undermine Obamacare. So literally from the 1940’s to today we still don’t have a universal approach to health care. That’s left New York City in a really bad place where hundreds of thousands of people don’t have anywhere to turn. We wanted to solve that problem for our people but there’s no question that also puts pressure on Albany to act and one day it might contribute to putting pressure on Washington to act as well – to see that it can be done and it needs to be done.

Question: So there’s no politics there?

Mayor: There’s, the politics of the fact that we have a system that is broken in our nation and has to be addressed and we, in this city are doing something about it and other cities have to take matters in their own hands as well. That’s a political reality. The reason we are doing this is to help people, I hope it has the effect of creating real momentum for change in Albany and Washington.

Question: Mayor, with New York City taking the lead in coverage for all, including undocumented, is it possible then that New York City becomes a magnet for people who have some illness that they want to get treated and come here for?

Mayor: It’s a very fair question Rich but you know, we’ve seen other situations where this city is a very compassionate city, it has been for generations but we have not seen evidence of that with other things that we do honestly. I mean I’ve this question very systematically of my team on other fronts. We don’t see that. This is going to benefit the people who are here and part our community now. You know in the end, I think this is also part of coming to grips with the fact, for our city but even more so for our nation, hundreds of thousands of people here who are part of our community, part of our workforce, our neighbors – you know, we have to recognize that ignoring that reality isn’t getting us anywhere. In the country it’s 11 or 12 million people and if they are sick all the time, do we think that’s moral, do we think that’s healthy, do we think that’s smart? No. They need to be, they need care too, we want them to be healthy for themselves, for their kids, in their workplace, for everyone. So I think this is very practical in the end, while simultaneously, you know based on a set of values that we hold in this city. If everyone knows they can get health care, people will actually go and get it. But up to now, people have thought, you know, I don’t know how to get that, it’s not for me, it’s too expensive, it’s too difficult and they don’t get it, and they put it off, including our young people and one of the things we saw in the research was striking. A lot of young people, as I said, some of them you would call working class, some of them you might even call middle class, delay getting insurance at their own peril. We want to make it really easy for them too, to get insurance and that’s better for everyone. Go ahead Grace.

Question: Question about the cost of this because there is a sliding scale, is that right? And so who gets insurance for free and who is going to have to pay and how is that determined?

Mayor: So again what we will do in this session is give you the top lines, more detail will come out in the course of day, we’ve been joined by our Budget Director Melanie Hartzog, so between Melanie, Herminia, Mitch – who wants to describe the basics of the sliding scale concept?

President and CEO Katz: Sliding scale will be for all of the services, it will slide to zero for people who don’t have resources, for people who have the ability to pay, we will be expecting that people pay what they can.

Question: How do you determine, I mean this is come up in the Fair Fares program, how do you determine sort of what someone’s income is, what they can pay, it seems fairly complicated –

Mayor: Big difference to begin – this is literally universal. So we are first getting people health care, I want to make sure that’s really, really clear. Unlike the stereotype of old of like, you know, before we deal with your perfuse bleeding, fill out these forms, oh wait you don’t have an insurance card, you know, see you – no. First we are getting your health care, and then we are working out the finances. But go ahead on how sliding scales generally work.

Deputy Mayor Palacio: So we have some experience to build on right? So we have MetroPlus which already operates on a sliding scale, Health + Hospitals has lots of experience operating on a sliding scale, so we have the experience to build on to know how to assess.

Mayor: Gloria.

Question: Mr. Mayor, just to follow up on that question, specifically with the question of this being accessible to undocumented immigrants who might have trouble providing proof of income or showing how much they are earning –

Mayor: Fair point.

Question: – sliding scale, so how do you determine that? And then I have a follow up question regarding –

Mayor: Let’s just do that first and then we will come to it. Go ahead, it’s a great question.

President and CEO Katz: It’s part of our everyday life is to talk to people about their sources of income and we understand that not everybody necessarily has filed an income tax return because they haven’t, they may not have a social security number but our financial counselors are used to talking to people about what their sources of income are.

Mayor: And just to play that through and undocumented folks like everyone else, you get different answers from different people. Right? I mean just to clarify for that.

President and CEO Katz: Absolutely.

Mayor: Okay.

Question: Is there anything that’s going to be made part of this program to address people’s concerns that if they are coming into provide information about where they live, residency requirement, you’ve had some of those concerns with the municipal ID program and the federal government possibly being able to tap into that information. Are you going to put any similar safe guards in this to ensure that people –

Mayor: Absolutely. So first of all I think it’s a great point to raise the ID NYC program because in fact as you’ve seen hundreds of thousands of undocumented people and many more hundreds of thousands of documented people have participated in ID NYC and I think they gained confidence when they saw that their background information was never shared with the federal government and we were able to destroy it. Since then in that program as you know, we’ve reduced even what we ask on the front end. But in this case, right now in Health + Hospitals, documentation status is not asked, just the way our police do not ask documentation status. So right there I think there is a tremendous amount of trust but yes, on any information, any paperwork it will not be accessible to the federal government. Juliette?

Question: Mr. Mayor, so when does it start, how do people apply? And where is the money coming from?

Mayor: So MetroPlus, which is our public option version of health insurance exists but we are going to get it to a lot more people. That’s going to start immediately, getting an intensive outreach effort around that. Then as that’s being done, a whole customer service apparatus is being built out to make MetroPlus work a lot better for people. And this is a little bit chicken and egg – people will sign up for something if they hear about it and know about it but they will also sign up as they have good experiences or people in their lives have good experiences with it. The more people see an improvement of customer service and it’s easy to use and it’s fast, the more and more people will get involved. So that will be ongoing but starting immediately. The efforts particularly focused on some of the folks who are undocumented, as you heard, a lot of that will be in place starting this summer, that will build out. When it’s all brought together, it’s going to take about two years to get to, two years or a little bit more to get to full strength but we want to start seeing people take advantage of this quickly with the tools we have and then they will get better and more extensive over the course of the two years.

Question: So then, is this the alternative to Obamacare? How would it work?

Mayor: So I’ll start and then pass to my colleagues. Look obviously there are people who are undocumented who cannot access any form of traditional health insurance, cannot access Obamacare, that’s 300,000 right there. Of the remaining 300,000 there’s a certain number who can’t afford any of the programs currently on the exchange. And then there are people who do not find the insurance on the exchange either understandable or appealing. And we think there is a big audience there that we can pull into this type of approach, particularly when they hear from the beginning, you get given a primary care doctor that will be someone you can turn to regularly. I think that’s going to be an important feature here.

Question: How is this funded? Where is this coming out of the budget, what part of the budget?

Mayor: Well as I said, earlier, it’s first of all taking the money we already have and as I said we’ve been joined by our Budget Director and feel free to jump in anytime you would like and we will get people more detail over the course of the day but the big picture is taking the money we have now and being able to use it better because we are going to have everyone covered and that means everyone will focus on primary and preventative care and not end up in the emergency room, not end up a hospitalization so partly is taking the money we have now and being able to do a lot more with it. On top on the fact that Health + Hospitals has just gotten a lot better at using the money they have. And then another part of this is the $100 million that we will add into the budget.

Question: Can you address that?

Mayor: Yes please.

Question: It’s a $100 million, where that’s coming from?

Mayor: Sure, Mel you want to speak to that?

Budget Director Melanie Hartzog, Office of Management and Budget: Sure so we do anticipate that at you know, at full ramp up, that there are incremental costs that we would add to the budget that would be at least $100 million as the program ramps up. Currently H + H is in a very good cash position as we move forward, with looking at the implementation we are going to monitor where they are and see if we need to add funding for the ramp up portion of it.

Mayor: But just, I want to split that into two, and then Mel, you can speak to it further if you need to. Juliette, I think it’s important to realize a few years ago, H + H was hemorrhaging money – I mean we were having to fund it out of the city budget to keep it afloat. I had a very pleasant conversation with these two individuals at the end of the row a few months ago where they said they are running a surplus now. So that’s a really important piece of this equation where this huge agency, that a few years ago was teetering on bankruptcy is now running a surplus. That surplus money is part of what’s allowing for this. But the second point is you know we’ll put in the $100 million as a budget priority. I think it will be money very well spent. Again I think over time we are going to see more and more savings off of that as more and more people pick up the coverage and get used to using it. But this to me is a really smart down payment on a lot of good things that will yield later on. Who hasn’t gone yet? Way back – Jillian?

Question: Mayor, just, you know you have talked about the young, invincible – people who think that they don’t need health insurance – are you anticipating that they are going to go to the NYC Care side of the program or the MetroPlus because aren’t they already able to look at what’s on MetroPlus now and decide like I don’t need to spend this money because I’m young and healthy?

Mayor: I’ll start and my colleagues will jump in. I think we are talking about a much better MetroPlus so this is a public option that’s going to work for people. It’s going to be modern, it’s going to be user friendly, highly facilitated, you call a number, you get the help you need. Easy to sign up for, you get as primary care doctor, I think most peoples’ image of insurance is like most of us have lived, here’s your card, good luck out there. Right? I mean if you are lucky enough to have insurance, here’s your card, go figure it out. We don’t do a whole lot after that to help you, good luck. We are talking about a highly facilitated system that I think a lot of people including younger folks who may have not have felt about insurance, they are going to feel better about it because it’s going to be easy to use and it’s going to be very clear how you get the help you need. Also you know there are a certain amount of young people who are not thrilled with giving their money to a big, for profit insurance company. You know I think we will be comforted to know this is a public option – something that I think will appeal to people. It’s in every neighborhood. I think the quality as it builds out is going to be the difference maker. Either one of you want to add? Good, okay way back, Jillian.

Question: Just to follow up on the H + H budget – do you also see this as sort of a way to build a new customer or patient base for H + H? I mean as you said you know a couple years of ago it was looking like H + H wasn’t going to be able to make the pay roll one point, that the cash flow was so low. Do you see this is a way to get more people into the city’s hospitals after people were kind of leaving?

President and CEO Katz: I see it as a way of meeting the need in the community and keeping people out of the hospital.

Mayor: Let me square it – I think that’s a true statement but I think it’s going to show more and more New Yorkers that — okay who’s got the technical difficulties over here? Let’s turn off that phone for all of us please. The, it’s going to show more and more New Yorkers that they can get what they need through Health + Hospitals, unquestionably. But yes, the more it works, the fewer people are going to have to turn to the emergency room or turn to hospitalization because they are getting that primary and preventative care. Way back –

Question: So NYC Care considered the –

Mayor: Wait a minute, I can’t see. Why don’t you stand up a little? There you go.

Question: [Inaudible] from Politico. Is NYC Care considered like the big umbrella [inaudible] really push Metro Plus? Like is that the one that you’re really going to pushing, you get cards for, and then you’re able to kind of keep people within H + H to avoid leakage versus going to the voluntary hospital?

Mayor: I’m going to start, and pass it to these guys.

Question: Great.

Mayor: NYC Care, the umbrella concept – everyone covered, guaranteed health care.MetroPlus is the public option. It’s the health insurance that can work for a lot of people. But remember, you’re starting with 300,000 people who cannot access Metro Plus; NYC Care will still help them directly. You want to add?

Deputy Mayor Palacio: Yes, so this is as you say both but NYC Care for those people who are uninsured is about also making sure that they have a care system, a delivery system that is user friendly, that is easy, that is accessible, that is quality, that is the care that people deserve even when they don’t have insurance.

Question: So the 300,000 people are really the ones that you’re trying to target? H+H already treats people regardless of their ability to pay.

Mayor: But again, I don’t want you to miss the sort of foundational point that we treat people regardless of their ability to pay but the wrong way, because they traditionally are coming in when it’s too late or a lot people are at least. And a whole lot of other people who could have that public option insurance are not taking it up, because they either don’t know about it or they don’t think it works for them or it’s not user friendly enough or whatever it is. We’re trying to combine these concepts into one idea. If – I guarantee you, because we just went through this for pre-K so we have a real living breathing model. The minute New Yorkers knew it was guaranteed, everyone got it, everyone connected to it who wanted it. It was – it took all of the mystery out of it. Now, we could have said, oh we’ve got this program here, and then the next week announce another program and ones for the undocumented, one was for people who are documented. We didn’t want to do that; we wanted to say to everyone one fell swoop. Everybody has access to health care now, everyone is guaranteed health care to make it really simple and straight forward. Because if it’s not simple and straight forward, people will not take it up or they will understand it. So we’re going to work with everyone to understand the specifics of each piece. But the umbrella concept is crucial here. Whoever you are, if you don’t have existing health insurance, this will get you coverage. Way back.

Question: [Inaudible] Mr. Mayor. To further simplify things, John or Jane Doe is sick, how does this work? How does this work for them? What happens?

Mayor: You are my personal hero. That’s exactly how we need to talk about things. Okay, I’m going to start, and pass it to the experts. John or Jane Doe is sick, now they know exactly where to go. They have a doctor with a name, and an address that’s their doctor, they know it’s affordable; they’re encouraged to go to the doctor as soon as they feel sick. How many people in our lives are walking around sick and were like hey you should go to the doctor and they come up with every kind of excuse. But for a lot of people it is I don’t have a doctor, I don’t know where to turn, I can’t afford it. We want it to be seamless. You feeling sick? Go to the doctor. It’s easy to know where your doctor is, who your doctor is. If you have questions, here is where you call. You going to get a human being, who is going to answer your questions, help you make sense of it.

President and CEO Katz: Someone who feels sick and they think oh I better not go to the hospital, I better not go to the doctor, I won’t be able to afford it now. But now that they’ve heard the Mayor’s announcement, they know health care for New Yorkers is guaranteed. It may not be that way in the rest of the country, but here I can afford it because health care is guaranteed to everybody at an affordable price. Now there is a number I can call if I don’t yet have a primary care provider, and I’ve heard that I can now be connected to a primary care provider if they do go to the emergency room, then the emergency room will be able to say the next time you feel this way you couldn’t see your own primary care doctor, so here’s how.

Question: So how do you get the primary care you talked about?

Mayor: So, the initial – I am going even to the very beginning. You call 3-1-1, so this is just starting, but when this thing is fully up and running, you call 3-1-1 or you go online to the city website and you can right then and there get your card and get the name of the doctor. It’s as simple as that. I mean that gets connected you to, to where you go the name of the doctor.

Question: And who are the doctors?

Mayor: And who are the – this is really basic stuff. Who are the doctors?

Deputy Mayor Palacio: The doctors are behind us.

[Applause]

Mayor: That part was easy.

Deputy Mayor Palacio: But it’s also important to know the vision for this, right. You asked a very specific question that somebody needs this care, so they call the number and they have a primary care doctor. Let’s say that they are having an afterhours issue and they need understanding about where to get a prescription filled, so they can call this number and get real time help about what pharmacy would be open, where they could get their prescription filled. They might call and say well, I am having a sore throat. Where can I go in for an urgent care appointment? They’ll get real time information about how to do that. This is the type of patient centered, patient friendly, dignity, quality care that we will be providing.

Mayor: So just to finish and then Mitch, I want you to talk about the pharmacy element which is important. So again, 3-1-1 or our website to apply, and then once you’re in – this helpline, 24/7 to help you navigate. And again this city has some really good examples; 3-1-1 does a lot for people. We did a facilitated enrollment initiative around pre-K and 3-K that’s gotten rave reviews because it was very user friendly, very positive like let’s get to yes, let’s find you the right place for your kid no matter how many times it takes we’re going to work it through. This is the attitude that will be part of this which has never been seen before by New Yorkers. It’s never been before the case that you have a single place to turn for health care if your current options aren’t working for you. You have a single place to turn and you’re going to get facilitation to get you to what you need and the answer is going to be yes. You need primary care? Yes. You need mental health services? Yes. You need pharmacy? Take it away, Mitch.

President and CEO Katz: Prescription drugs are one of the thigs that people most worry about. How will I be able to afford that medication that I need. Under this program all pharmaceutical costs are covered so that people can be certain that if they go to the doctor and the doctor gives them a prescription and they can’t fill it that’s still not addressed their care. This program includes pharmacy.

Mayor: I know Chirlane wants to add.

First Lady McCray: I just want to add that if someone calls 1-8-8-8-N-Y-C-W-E-L-L which is our number for anyone who wants to speak to a trained mental health counselor or a peer they can be connected to a professional – while they’re online speaking to one of these trained counselor, they’ll get connected to someone who they can go to get their pay from.

Mayor: So I want to make that – just pull that out a little more. So this means for folks who are on the line with NYC Well and they’re talking to the trained counselors and they say I am looking for a place I can get therapy but I don’t have insurance. Right now we’re going to connect those dots. Because now we have a way of saying okay, we’re going to get you coverage. We’re going to start by getting you coverage and then that coverage has mental health services as part of it. So it’s adding a whole new richness to what the NYC Well initiative can do. Okay we’re going to go back to front just to get people who haven’t had a chance. Who has not had a chance, go ahead.

Question: [Inaudible]

Mayor: No, no I am going back to front. We’re getting to you. Go ahead, way back, way back.

Question: I have a question about –

Mayor: Get up, so we can – get up a little bit so we can see you. There you go.

Question: Pharmacy question. So I worked for many years and the pharmacies goes on –

Mayor: I am sorry, are you media or not?

Question: No, I am a physician.

Mayor: We love physicians but we’re just doing media questions right now. Can we just do that? Okay, go ahead.

Question: Mr. Mayor, I don’t mean to be pushy. But can people call right away to 3-1-1 and start enrolling or will there be an eventual 800 number like the other that we have with NYC Thrive. Is that being worked on? And the other question is –

Mayor: Wait, wait, stay on the first one. A pushy New Yorker, what? I’ve never seen such a thing.

[Laughter]

So, you should have said, I don’t mean to be normal. But – so –

Question: [Inaudible]

Mayor: Yeah, and that’s right. So, again our colleagues will speak to it. MetroPlus in its current form is available now but again it’s going to be rapidly improved and made much more available. Some of the other pieces have to be built out more. Why don’t you guys speak to – just help people understand what’s right now and then the other stuff gets built out over the next two years.

President and CEO Katz: So for half the population who are eligible we can start to help them right now with coverage. For those people who are not yet eligible for coverage we are providing health care at all our facilities, including this great hospital, Lincoln. But we over the next few months because of the Mayor’s commitment we’re really going to be able to provide a much better customer service. Again, some 1-8-0-0 numbers are information. There are lots of those that will give you some 800 number that nobody else will answer. This is really as in I have a prescription, it’s 11 o’clock at night, I need it filled. Where do I go? Or I need to see a specialist and I was told that there was a three week wait, where do I go. So that’s what will be available as of this summer. Right and I just want to pull out one more point. You’ll get your second question. I keep coming back to the pre-K analogy because I think it’s a helpful one. When we started there were families who could get full day pre-K for free. They were not the majority, but there were some families. We took what existed and we built on it to make it fully universal. There’s a similarity here. There are some people now getting insurance through MetroPlus and there are certainly people getting health care at Health + Hospitals facilities. What is not available consistently is a universal approach, easy to use approach. There’s a whole lot of people who could be getting insurance who are not getting it or don’t understand it. There’s a lot of folks who are undocumented who are coming in for the emergency room but not for primary care as an alternative. So what we have is some of the pieces. The goal here is to take everything up many levels to a fully comprehensive system that everyone understands, everyone have access, everyone assumes is theirs and is available 24/7 where the emergency room again becomes a last resort, not the first resort. So it will take several steps over basically two years. Some of them right now, some of them will build out. But the difference in terms of being able to feel it and explain it to your viewers, the difference is right now we’ve got something very disjointed honestly for 600,000 people means they get either no care or limited care. We want to get those 600,000 people consistent care whenever they need it. That’s the difference. What’s your next question?

Question: Yeah, so just 3-1-1 then I’ll refer them there and NYC Care will be their magic word because some of them don’t speak English as you know.

Mayor: Well, 3-1-1 is multi-lingual obviously, but yeah.

Question: So they can refer us to NYC Care and the health [inaudible] and they’ll be able to be assisted.

Mayor: Right, over time. But again, I think the first point is for folks who might qualify for insurance they should say I am trying to find health insurance no connect them to Get Covered and anyone who might qualify that’s the way to go. For someone who might be undocumented this is still not fully up and running obviously if they have an immediate need they would go to Health + Hospitals for the kind of services that exist now. Do you want to add?

Deputy Mayor Palacio: Yeah, that’s all I was going to say. If they call 3-1-1 and they require medical care, they can get connected, and they don’t have insurance – 3-1-1 can connect them to Health + Hospitals.

Mayor: Okay, I am going to go to the middle because you’ve been waiting so patiently and then we’ll go back, go ahead.

Question: Very kind, thank you, Mayor. And look inevitability there is going to be criticism.

Mayor: What?

[Laughter]

Question: I know hard to believe.

Mayor: No one braced me for this.

Question: This one is from Nicole Malliotakis. “Our citizens have a hard enough time covering their own health care costs and now Mayor de Blasio also wants them to pay for health care for 300,000 citizens of other countries. The Mayor must stop abusing the middle class and treating us like his personal ATM.” Can you just respond [inaudible]?

Mayor: Sure.

Question: Specifically to that, just generally to the criticism [inaudible].

Mayor: I am shocked, shocked to hear a criticism coming from that corner. The – first of all can we talk about common humanity for a moment? 300,000 human beings who don’t have a place to turn for the kind of health care they need and deserve. That’s not in any of our interests. They are our neighbors; they work right next to us wherever we work. They help to keep the city going and its true to the whole country. So I just, I just refuse the notion that these folks don’t deserve health care and I refuse the fiction that they have some other place to turn for it that’s so wonderful and easy. Like let’s deal with real world. This is a way to get everyone health care. It’s going to ultimately not only be the morally right choice, it will save the tax-payers a lot of money in the end because people will get health care and they will be healthier and we won’t be paying for the kinds of things that happen when people are not healthy. I don’t want to see families torn apart because someone got sick and died who could have been saved. That’s not in the interest of the “middle class”. I think the whole critique misses the values of this city and our common humanity. And I think the notion here is that everyone will benefit from single payer.

Let’s be clear, everyone, middle class, working class, poor. Everyone would benefit from a single payer system. Our country has been struggling its way to it, since Harry Truman talked about it in the aftermath of the New Deal, we’re still not there. But New York City has an opportunity to do something historic here, to do something for our people and also create momentum. I am absolutely proud of that fact, and I think for a lot middle class New Yorkers if this is a step along the way to the day that everyone knows their health care will actually work for them. Well, that will be good for everyone. Okay, way back. Yes?

Question: This is a question about pharmaceutical access. I know physicians like the one behind me. They – part of the problem with patients is pharmacy hours are not – they’re not open on weekends. Is there a plan for the city to expand pharmacy hours to make pick up more accessible? And then the other – it’s a two part question.

Mayor: Okay, let’s just do that first and we’ll come right back.

President and CEO Katz: Yes.

Mayor: Yes.

[Laughter]

Would you care to elaborate?

President and CEO Katz: Yes, I mean part of this enhancement is all about customer service. Everybody has always known that Health + Hospitals had great doctors and nurses. It’s fixing the patient experience and part of the patient experience is if a great doctor or nurse gives you a prescription, you have to be able to fill it. So, that’s one of the enhancements.

Mayor: And what’s your second? Go ahead.

Question: I know – how will this plan affect the profit from the [inaudible] –

Mayor: The what?

Question: The city’s plan where they purchase pharmaceuticals that are cheaper prices.

President and CEO Katz: So, it takes advantage of that but there’s no profit associated with it. But yes, you’re right, Health + Hospitals is able to get medications at 340B prices which helps to make this affordable for us.

Question: Mr. Mayor, [inaudible] familiar with [inaudible] and MetroPlus. Now, what is the turnover rate of doctors here at HHC presently and will people need referrals to go to doctors or to the specialists, I should say, and have tests done, and will they be given options or be told where they’re going?

Mayor: Go ahead, Mitch.

President and CEO Katz: The – I don’t have for you an exact number of what our physician turnover is. I’m proud that so many of the physicians behind me actually trained at Health + Hospitals at one of our residency programs. We have good longevity of our physicians. So, for me that’s a very positive aspect. The second half was on what, I’m sorry?

Mayor: Will people be –

Question: Referrals to see those specialists.

President and CEO Katz: Yes, and that is part in having access to specialty care – like pharmaceuticals is a necessary part of health care, and we will make sure that people have timely access to a specialist.

Question: What about [inaudible] or will they be shown to one specific person or area –

President and CEO Katz: In other words, someone says I want to go to Presby because that’s where the particular specialist I wish – that may or may not be possible. But certainly it is meant – I can assure that people will be seeing a competent well-trained caring physician.

Question: [Inaudible]

President and CEO Katz: In network.

Mayor: Okay, we’re going back. Who else? Go ahead.

Question: Does this include any coverage for dental [inaudible]?

President and CEO Katz: Dental services are provided at Health + Hospitals at multiple facilities at the current time. We’re still working on the exact benefit package. For now, I would just say that we’re doing dental as a separate issue for people who need it at Health + Hospitals.

Mayor: Who has not gone? Go ahead.

Question: Can you describe how NYC Care will compare to MetroPlus. Is it the same services, equal services, or will it be like a light MetroPlus?

President and CEO Katz: In terms of quality of care, it will not be light it will be equal. What is different is that because MetroPlus is insurance, it would cover somebody who got sick in Ohio as insurance needs to –

Mayor: Wait, can we clarify that statement. It would cover a New Yorker who is travelling to Ohio and happen to get sick there.

President and CEO Katz: Yes, sorry. Yes, Sir. Well done, Sir, yes. If a New Yorker –

Mayor: I’m like, what the hell did he say.

[Laughter]

President and CEO Katz: If a New Yorker went to Ohio – thank you, Sir – they would be fully covered under MetroPlus. The NYC Care is a program that takes advantage – leverages the Health + Hospitals system. So, there is no coverage for people outside of the city.

Mayor: Yes, please.

Question: How much closer does this put you to your enrollment goal for MetroPlus?

President and CEO Katz: At the moment, MetroPlus doesn’t have a specific enrollment goal. I have always wanted it – I think it serves so well as a public option but we want to see it grow but we don’t have a specific number attached to it.

Mayor: Yes, I just want to add on to that. Without a specific enrollment goal, I want to make the broader point. This becomes a true public option because it’s going to be built to be as accessible as possible, it’s going to be built to be really appealing and easy to use. You know, again, we struggled the last few years to keep Health + Hospitals going and to make MetroPlus better.

That evolution has happened very rapidly and it is a good news story, and now we’re in a position to really make this a full blown public option that a lot of people can and will want to use. So, I think it’s clear – where there’s 300,000 worth of potential growth to it, is every single one of them going to take it? No, but a lot of them will.

Who has not had a question yet, please? I just want to, in the interest – don’t try that, Jillian. That was – who has not. I think everyone has. Okay, we’re going to go back around and go from the front to the back. David?

Question: [Inaudible]

Mayor: Media question? Media questions?

Question: I’m a member of – I represent This is the Bronx.

Mayor: We love the Bronx. Go ahead.

Question: We know that the New York Health Act will cover everyone in the same way –

Mayor: You mean the Gottfried Bill, the single-payer bill?

Question: Yes.

Mayor: Yes.

Question: So, I view what you’re saying as a stop gap until the New York Health Act is passed because everyone knows that a public option is a [inaudible] to insurance companies. They love it. Schumer supports it. But we need guaranteed health care equally –

Mayor: I get your point – you’re making a little bit of a speech and I’m just going to respond to the underlying question. As I said earlier, I, 100 percent, believe in single-payer. The ideal single-payer would be national, single-payer [inaudible] Medicare for All is obviously an example.

Obviously, if you can’t get national, I would love to see the State Legislature pass single-payer in this session but we are not convinced they are going to do it. I’m going to fight for it and I’d like to see them do it. This is a way of getting people health care here and now regardless of what happens at the State level or at the federal level. Okay, David.

Question: Two questions – is the number going to be 800-NYC-Care or something like, or –

Mayor: I don’t know if we have the number yet. Do we – no, we will cut back to you when we have the number.

Question: And when the number launch, do you know?

Mayor: Do we have a rough date on the number? That’s a no. We’re going to come back to you with a date on the number.

Question: And the other question is – Dr. Katz, when you were in San Francisco, you had a similar plan. How does this compare to – I think it was called Healthy San Francisco –

President and CEO Katz: Right, so, this takes advantage of the fact that New York City has – in large part because of this mayor – a much broader set of services, a more comprehensive benefit. So, for example, here psychotherapy is a covered benefit which was not true in San Francisco – much broad substance treatment services, much broader reproductive rights services for women. So, it is a broader benefit package and also frankly while I’m very proud of the work in San Francisco, the current program has an enrollment of about 20,000 people. That’s a New York City block in terms of –

Mayor: Spoken like a true Brooklynite –

[Laughter]

President and CEO Katz: I think I lived on that block –

[Laughter]

So, in terms of scale this is just a much broader scale.

Question: [Inaudible] already New York City has these things available –

President and CEO Katz: They are part of the network and so when we put together the program then people who will be part of NYC Care will have access to a much broader array of mental health and substance treatment services, reproductive rights services, that Health San Francisco –

Mayor: Yeah, and David, I think it’s important to recognize, these things have never been combined into a single plan, a single vision. And this is really the breakthrough we’ve been working on for years. It’s to try and come up with a single universal approach.

The absence of a universal approach was holding us back and Health + Hospital progressed. That was a big part of it but it was also a decision that only by covering everyone could we get health care to work in this city the way it should. I think what happened in San Francisco and L.A. was commendable. I think the San Francisco and L.A. models were not predicated upon the notion of literally the goal is to cover every single person to have pure universal health care. This is a – and also San Francisco, I want to note, came with an employer mandate that had a cost to employers which was controversial. We found a way to do that, to do something of this scale without that.

Question: [Inaudible] covering everyone prior to this – what you said before, you weren’t covering everyone in the right way?

Mayor: Well, yes and no – more on the no, in my view. Uninsured people in that 300,000-person pool weren’t getting health care. It’s just a cold reality. So, we were only covering them in the sense that they could to the emergency room. It was not a way to live. I think this is the crucial difference. It was not the right way to get health care because it wasn’t structured to encourage people to get health care the right way, and it wasn’t universal either in message or in the way it was used. And then for folks who are undocumented, It’s kind of the same story unfortunately.

It was a heavy emphasis on emergency room and dealing with crisis rather than come in, you’re guaranteed a primary care doctor – that is probably one of the things in terms of explaining it to your readers, that’s most essential here.

The universal concept now is everyone will be assigned a primary care doctor. And then the universal concept behind that is that everyone can get a very broad range of specialty care that that doctor will send them to, and it’s all covered. And that includes the mental health piece of the equation which clearly has never been considered by people as something they could easily access. This interplays with Thrive very powerfully because it says now to 600,000 people, if you need something in the way of mental health care, we’ve got a really care runway to get it to you.

First Lady McCray: Yeah, most people wait ten years before seeking mental health care which is much too long and the only thing that can happen during that ten-year period is that the disease gets worse.

Mayor: That’s the American average.

First Lady McCray: That’s right. That’s the American average.

Mayor: From manifestation of a health care – a mental health care condition until treatment, in this country, the average is – people wait ten years to either decide to act on it or know they can act on it or find some place where they can get help which is incredibly destructive.

First Lady McCray: That’s right. People end up in crisis situations when they don’t have to be.

Mayor: And if we had single-payer, I think that situation would have been changed a long time ago if everyone knew mental health care was easily accessible and affordable. This has been one of the missing links that really again synergizes with Thrive that now everyone in New York City will know there is a way to get to mental health care that is covered.

Deputy Mayor Palacio: And I just wanted to add, the Mayor – I wanted to really strengthen and add to what the Mayor said. You know, people were getting care not in the right way. Health + Hospitals was built around being a hospital system, an inpatient system. We have in the transformation really focused to move to an ambulatory system, to providing the right care for the right person at the right time, and this built on that, and is really going all out to take that right care, right person, right time to the next level. We’re not there yet and this is a program that’s going to help us get there for every New Yorker.

Question: In recent years, I’ve curious about the kind of financial health of the public hospital system because in recent years the City was including hundreds of millions of dollars in budget modifications for HHC. Now, you’re saying you’ve progressed, you’ve hired a lot of new primary care doctors, the MetroPlus system is going to improve. What’s been going – I mean this is since fairly recently. So, what’s been going on –

Mayor: Yeah it’s –

Question: [Inaudible]

Mayor: Yeah, it’s amazing. It’s a very powerful story. And it’s also a reminder – again, everyone rightfully, not just in the media but the citizenry, looks at government agencies when they have problems and thinks this is a problem of bureaucracy or whatever it may be. But it’s important to recognize that agencies can really turn around. Not just this example which I’ll talk about but School Construction Authority is a great example. It used to be a basket case – it’s not a picture of efficiency and effectiveness. We intend to consistently apply approaches to agencies that need improvement because we’ve seen how quickly they can turn around.

So, H+H when I came into office, it was struggling and you’re right there were a couple of years where we had really urgent budgetary needs that we had to address there and we had to add City money. I think some of the change began with Dr. Raju. I think a lot more then accelerated under Stan Brezenoff and a lot more then has accelerated under Mitch Katz.

And I think it is a bit of a question of momentum that as they started to turn the supertanker, they found they could turn it faster and faster. But I’m telling you, I had heard for the first time just weeks ago the concept of a surplus at Health + Hospitals. That is an idea that would have been unimaginable four or five years ago.

They finally got it there and I really want to give Mitch credit because he is doing this very fast which he has a history of doing. You can see some of the stuff he did in L.A. before here. It’s opened up a world of possibilities. So, that was one of the missing links in trying to get to universal health care – it’s that we needed H+H to be a lot stronger, and now it’s on that path.

Marcia?

Question: [Inaudible] number one – if somebody gets sick, how long will they have to wait [inaudible] how long they will have to wait for an appointment because if you feel sick and you have to wait the one or two weeks for an appointment as Dr. Katz said, you’re probably going to go to the ER anyway. So, how do you speed that up so that they don’t go the ER?

Mayor: Absolutely, great question. The goal of course – and I’ll pass to Dr. Katz – the goal is to get people to care as quickly as possible. And remember once they’ve established a relationship with that primary care doctor, they’re going to go straight to them. They’re going to be able to turn to the doctor without having to go through any intermediary. But we need people to be able to get the care as quickly as possible. We’re starting that kind of timeline. By the way, for a lot of people I can say from my own experience with primary care doctors, you don’t always get to see them the exact same day. There’s often a bit of wait but our goal is to make that as quick as possible.

President and CEO Katz: If you were a patient at Gouverneur, which is where I work as a primary care doctor, you would be able to seen today or tomorrow if you were an established patient which is part of why we want people to be established and then we set aside a certain amount of appointments. If you needed urgent care, Lincoln Hospital is one of our two hospitals going forward with an urgent care system so you don’t have to wait the long time –

Mayor: But that’s not an emergency room – very important. That’s care without the cost and complications of going to the emergency room.

President and CEO Katz: Well said, Sir.

Mayor: You’ve trained me well.

Question: [Inaudible] clinics that you say that are going to be available – is there a build out here [inaudible] exist? Or do you have to build them and will you be building them out starting in the Bronx [inaudible] how does this work?

Mayor: Right, right and so we have a wonderful system now but again it’s being changed. The introduction of urgent care here and Elmhurst is an evolution for Health + Hospitals. Again, a few years ago the notion of Health + Hospitals having its own urgent care capacity would have been ludacris honestly. It was like an emergency room and now they’re creating whole new things that are going to make it, I think, a lot more appealing and usable for people. So, there’s existing facilities – we did open one recently in –

Question: [Inaudible]

Mayor: Hold on – let me finish and then you’re going to get your answer. We just opened a new facility on Staten Island as part of our build out plan for clinics in general. But Mitch, to the question of how you’re going to use the facilities to achieve this plan, and how quickly people are going to be able to access it.

President and CEO Katz: The 70 clinics are currently available but we are opening new facilities. The Mayor mentioned the one he did the ribbon cutting in Staten Island. There are three news ones that we’re planning on opening up in the next year. But the 70 are already open and we have both – if you want a primary care doctor, we can get you that within the next week or two. If you’re an established person we can get you seen today or tomorrow. If you don’t yet have someone and you need to be seen right away then we would send you to one of our urgent care centers so that you wouldn’t need the emergency department.

Mayor: Okay, Glora.

Question: You say that you’re looking at surplus at [inaudible] –

Mayor: We have a surplus – I’m trying to remember when the last reported surplus was.

Director Melanie Hartzog, Office of Management and Budget: I think just to state it clearly – H+H is in a very good cash position to – I believe a reporter who mentioned prior years, there was a lot of difficulties and the City was adding a considerable amount of subsidy money – their position right now, thanks to the work as the Mayor said of both Mitch and Stan and others, we now are in a very good cash position. So, that’s two pieces to it.

One if the efforts that have been taken to really right-size on the expense side looking at efficiencies. And the other has to do with a lot of revenue generation, better billing – we’ve invested a lot in revenue cycle management, capital improvements, to really enhance billing. And those initiatives that are part of the transformation plan are now coming to fruition.

Mayor: Okay, Grace.

Question: Right now if you’re an undocumented immigrant in New York or you don’t have health insurance you can walk into a public hospital and get care. Can you not get access to a primary care physician right now?

President and CEO Katz: So, it’s a combination of – so you can definitely walk into any emergency room. You can go to a clinic but what is missing is the good customer service to make sure that you get an available [inaudible] and just like any insurance system for example, you might go to a particular doctor’s office and they say, ‘I’m full,’ and then you would call your insurance company and they’d say, ‘But we have another clinic that’s available right near where you live or work.’ That’s what we’re missing and what the Mayor is providing. It’s that now you’ll be able to call that number so if the first place you went you know – that doctor, because she’s wonderful her panel is full, you get directed to some place where you can get a doctor within a week.

Question: But everyone is guaranteed – like currently the mission of H+H is—

Mayor: Right, but—

Question: –the Health + Hospital system is to provide health care to all—

Mayor: Grace is – the – of course the goal is always to be available to people. Here’s the reality: 600,000 people who do not have coverage and are not getting the health care they need. I mean this is just fact. 600,000 people who go to the emergency room instead of the primary doctor or put off care, or don’t have access to specialists – in some cases I agree with you. If they get to the emergency room it might eventually lead them those things. We don’t want it to be a hit or miss, we don’t want people to feel they have to go to the emergency room to access. We want to actually get the horse before the cart here and create a clear universal coverage system. Everyone knows – and I – you know think about in your own life. If you thought the only way you would get care was going to the emergency room, first of all, that’s not a great experience. People don’t want to go to the emergency room so it becomes like a perverse disincentive to get the care you need. It’s inconvenient – you wait long, long periods of time – that’s not what we’re looking for. We’re looking for getting it right the first time. You get signed up, you know you have coverage for a whole range of things, you get a primary care doctor, a real person with a real name and a real address – you get care on a regular basis. The emergency room becomes the last resort. We’re talking, you know, over a half million people for whom, unfortunately, that picture I painted is not the reality right now. They could be living a lot better life if they knew they had coverage and they could depend on it. Let’s just do a couple more and then we’re going to go to other topics, Jill, so I got two in the back, two in the front, and we’re done. Go ahead.

Question: Mayor, how is this program going to work on Staten Island which is the only borough that does not have a public hospital?

Mayor: Obviously we have Vanderbilt Clinic now, as a beginning, but any other things we want to say, I mean, the MetroPlus works everywhere so that’s half the people.

President and CEO Katz: Correct, it’s a comprehensive clinic and we would, if somebody needed hospital services we would help them to another, with transportation, to another Health + Hospital facility.

Mayor: Go ahead.

Question: [Inaudible] deductibles associated with NYC Care?

President and CEO Katz: There are for – under the MetroPlus, there are co-pays as there are with most insurance products that can range from zero to $30. We are still working on the details for New York City Cares but it’s certainly all sliding scale, based on people’s ability to pay.

Mayor: David?

Question: How much of the $100 million additional spending is going to be for setting up this hotline essentially. Just about a 100 some-odd people who work at NYC Well – that has a certain cost associated with it. I assume you need more people to work this hotline so you’re looking for a lot more people potentially, and have more direct and frequent contact.

Director Hartzog: I think the $100 million covers a number of different costs, doctors, additional doctors, nurses, and customer support services built in and I think how that plays out as we work with Mitch around the ramp up, we’ll have to get back to you on that.

Mayor: Right, this is a projection that’s a couple years off when we get to that spending level so we’re going to start at a more modest level but to make the point David, it is a combination of the direct service personnel and the whole mechanism for getting people connected the care and making it user friendly.

Question: On the surface question about Health + Hospitals, in December, IBO said that in the November plan for the city there’s $156 million shortfall we’re projected to be $1.8 billion by 2022. Has something changed in the last month?

Mayor: So we’re about to do the preliminary budget. Let’s agree that we won’t jump ahead – hold on over there, Melanie I want you to hear this – so, we’re about to do the preliminary budget very, very soon. We can give, later today, an initial answer but I want to be very careful about the fact that the preliminary budget is where we’re going to give the formal assessment of where this agency and every other agency stands.

Director Hartzog: But I will just and follow up up front: the IBO and other monitors put out their own assessment of what our risk is and I stand by our position which is that H+H is in a very good cash position that in fact is part of our – when we rolled out the transformation plan, they’re on target in achieving all of their goals within that, and so I think, you know, that is the IBO’s assessment, not ours.

Mayor: Well said, okay, last call.

Question: I want to ask about the people who don’t have insurance who are likely eligible for it. Is there the possibility here that the city is going to steer them toward a city funded option even though they would be eligible for the – a federal?

Mayor: No I mean, Get Covered NYC has been aggressively moving people to the exchange and I think the number is, someone help me, a hundred and what, thousand people? 130,000 people in two years, basically?

President and CEO Katz: Yes?

Mayor: Nod vigorously, okay. That, and thank you again to you and your colleagues, 130,000 New Yorkers have been signed up through the exchange, through the efforts of Get Covered NYC and that’s a whole range of different insurance products, obviously. It’s this last 300,000 that haven’t been moving much that we have to approach in a different way. So if someone, you know, if someone says “oh I want to go on the exchange,” if we’re reaching out to them and trying to engage with them, and they say “I want to go on the exchange,” great! We would love that. It is, however, we see a gap, there’s a group of people who are not choosing insurance, that’s one problem. Again, a lot of that tends to be younger folks, but not exclusively. There’s a group of people who can’t afford the exchange, but there’s a gap there and, you know, we’re New Yorkers so I say 300,000 people and it’s like ho-hum. You know, anywhere else that would be the whole city right? So, I mean, that’s a lot of people that so far the exchange is not giving them the answer they need and we’ve got to find something that breaks through, because we don’t want anyone to go around without coverage. Okay, we’re going to other – oh, Rich, last word and then we’ll switch over to other topics.

Question: How big is the projected pool of primary physicians that you’re going to need to run this—

Mayor: Excellent question.

Question: — and are they all HHC employees?

President and CEO Katz: So a primary care doctor can handle, generally, in the industry, about 1,500 individual patients so as the program ramps up and new people join the system, we would follow that ratio.

Mayor: Okay, we’re going to just turn over for a moment because these folks have lots of important stuff to do. So it’s just going to take a moment, we’ll go to off-topic in a moment.

Thank you, everyone.

[…]

Mayor: — city never sleeps, are we set, set, set, set, set? Let’s go, let’s let this nice lady sit down and we will go to, yes way back there?

Question: So, Governor Cuomo said he wants to blow up the MTA –

Mayor: I hope he doesn’t mean it literally.

Question: Do you have any thoughts or reactions to that?

Mayor: I haven’t seen all of his comments except I do see in what he’s saying, I’ve just again seen the top lines, any day the Governor and the State of New York are taking full responsibility for the MTA is a good day for New Yorkers. It is an acknowledgement of the accountability that we need so I commend him for that. Now I don’t know what it means, I want to know more about what his vision is but I appreciate that he is taking responsibility. I think that’s healthy. Okay other questions, yes Gloria?

Question: So two questions for you, one I wanted to ask you about the City Council bill that is being introduced to, so that public officials including yourself can raise money [inaudible] from donors to pay their legal bills. Assuming that’s about to be passed and get signed by you – your general comments on that and how do you plan to go about fundraising this money and that’s –

Mayor: So obviously the bill has not been passed and until there is a full legislative process we don’t know what the final wording will be but I believe there is a need in a democratic society in for this kind of mechanism, a legal defense fund is a very well established idea, it’s existed for decades because everyone has a right to a defense in America. And there has to be a way to pay for it and if you are a public servant there’s just no way to handle it, there has to be some alternative methodology and obviously this city has been very rigorous about how it approaches any issues about finances and ethics and I think that what’s begin talked about here is consistent with that approach.

Question: Will you disclose the donors in a way you have not done?

Mayor: Absolutely.

Question: And my other question was about the departure of your Taxi Commissioner –

Mayor: Yes.

Question: Just any sort of statement on it, talk about why she is leaving and if there, if any other recent disagreements on policy?

Mayor: No, no, no there’s one disagreement and I think it is a respectful one because I understand she’s looking out for a constituency and I want to make sure that that constituency is treated well but also we have to deal with the challenge of congestion and we have to deal with financing the MTA so I’m looking at a lot of different pieces of the equations. She’s particularly looking out for her constituency, I respect that. I do want to make sure that that surcharge is fair to yellow cab drivers and I want to make sure and green cab drivers, I want to make sure that it is handled properly. And I think there is still a lot to work through about how it is implemented as fairly as possible. So no, no she, look, she did a very tough job and she did it very well, and for four and a half years I’ve talked to her and she was just clear about it was time for a change and she clearly felt deeply for the people she served. I think she achieved a lot. I give her a lot of credit for the progress that we made in terms of finally creating some intelligent way to cap the number of for hire vehicles and the focus she put on rising up the incomes of for hire drivers and taxi drivers that really you know, no one before her managed to find these kinds of solutions so I think it’s very, very positive but I just think she got to a point where she had done a really grueling job for a long time and she was ready for a change. Okay, yes Marcia?

Question: Mr. Mayor, last week you had three opportunities where you took reporter’s questions. This week you have been doing it I think twice this week? I wonder if this is some kind of a new policy you’re turning over, a new leaf of transparency?

Mayor: I always believe in transparency so it’s something that we will do consistently but there’s a lot to talk about. This is, we are starting a year, it’s going to be a very vigorous year. You’re going to see a lot more in the State of the City on Thursday and there’s a lot to talk about. It was an important to have an opportunity to go over it with all of you and whenever we’ve got a lot to talk about we are going to be spending a lot of time together.

Question: Okay, I wanted to go back to your original platform in 2013.

Mayor: You may be the only person who ever read it but okay.

Question: Okay, here in the Bronx, of the 12 Bronx precincts, nine are up in either murders or rapes. Seven are up in both categories – about those hundred officers, six months ago that were assigned to Bronx precincts, I’ve been talking to police commanders, they are replacing officers that have retired or of the transit or other things so they have no net gains and in some precincts there are losses of officers –

Mayor: Okay, respectfully I am going to stop you in the beginning, I don’t know if you’ve cross checked your information with the NYPD, we would be very happy to allow you to do it. I’m perfectly comfortable if you’ve talked to individual officers but if you want the final word on numbers we want that to come from the NYPD. I was very honest as was Commissioner O’Neill last week that we are dealing with a reality that is very troubling when it comes to the increasing rapes but as based on something as far as we can tell and I think it’s fair to say most advocates, hold on, most advocates can tell that it’s about the actual numbers finally being honestly reported in a way they never were in the past. In other words for years and years that level, God forbid but is true, that level of rape and sexual assault appears to have been happening but going unreported, it’s finally coming out the way it needs to. We are going to be very eagle eyed if we think anything else is going on but that’s what we think we are seeing right now. But on the overall reality, I would have to remind you, overall crime is down, you know homicides again under 300, we always are looking for if there’s parts of the city that need more attention more help, and we will always give the Bronx whatever resources it needs but I want to be cautious in saying to you the overall trends have still been very consistent including for the Bronx.

Question: I want to go to one specific precinct, the 50th Precinct in the Bronx which was the safest precinct in the Bronx okay. In 1998, they had less than seven murders, they had seven murders this year so they are back to the rate of murders of 1998 –

Mayor: Again I can’t give you enough fine tuning –

Question: – the seven categories, crime is up, now in 1998, the 50th Precinct had 178 officers, currently they have 99 under –

Mayor: Again I’m going to respectfully – I can’t give you the details on that precinct because I don’t know them but we’ll make sure the NYPD speaks to it.

Question: – the Bronx are wondering why they are not feeling safe?

Mayor: People in the Bronx, like people in all five boroughs have seen a steady reduction in crime but we still know there’s places we have got a lot more to do. But I would just remind you and I’ve heard this from people in the Bronx just as much as I’ve heard it in the other four boroughs. There’s a strong understanding we are the safest big city in America, we’ve made a lot of progress but we still have more to do, so in terms of that particular precinct we will get you a clear answer from the NYPD if they need more resources we are always ready to do it. We have added 2,000 more officers on patrol in the last two years, we clearly have more to work with and will get them where they are needed.

Go ahead –

Question: Yesterday, some members of the Seattle City Council were in town saying that having an Amazon headquarters isn’t in some ways advantageous to a city. Can you respond to those comments?

Mayor: I didn’t get to see the whole report and I’d really be interested in talking to them, but I said this at various points – I have a critique of corporate America. I don’t for a moment think because a corporation shows up everything’s going to be perfect. I think it’s up to us to hold their feet to the fire. They made a series of commitments, we’re going to hold them to it, and then we’re going to push for more.

That said, unlike Seattle where they already existed, the difference here is getting a commitment to a minimum of 25,000 jobs – a maximum of 40,000 – new for our city is a very big deal and it’s very big deal for our tech community, which is a big part of our future. So, I think the reality in Seattle and here is different on a strategic level, but I think the concern that I believe they’re raising that companies need to be held accountable – I agree with that 100 percent. I agree with that whether you’re talking about a real estate developer or you’re talking about a tech company or anyone else. They need to be held accountable.

Question: Mayor, with the federal shutdown just, kind of, continuing – is the City at risk of losing or running out of federal money for programs like SNAP or [inaudible] and what happens when that happens? What’s the latest [inaudible]?

Mayor: Well, the day the shutdown began, I said that after you get passed the middle of January, it starts to be more of an issue, so we’re getting real close. Melanie can talk about the direct budget impact. Right now, before we even get to that, I would say the first concern is those 50,000 federal workers who work in New York City who are going without paychecks, they’re suffering, their families are suffering right now. I think you’re going to see the nonprofits that depend on federal money really in the tough place because they don’t have the kind of cash flow that the City government does. But a day will come if they don’t solve it in Washington where it will start to affect our abilities as well.

Director Hartzog: I think it’s just what you said, which is you start to really get concerned about where we are as we get to mid-January. In addition to SNAP, which we have, at this point, no indication that is currently from the federal government at risk. There’s also Section 8 subsidies as well, so it’s not just about SNAP but also about our Section 8 subsidies that are both at NYCHA and also at Housing Preservation and Development.

Question: And then, let me follow up on the Amazon question there – do you have any concerns about – you said Amazon isn’t here yet and that’s true in terms of their corporate presence, but there is a large distribution center on Staten Island where some employees recently started to unionize and there’s been some [inaudible] working conditions there. Have you looked into that at all and does it concern you?

Mayor: I don’t know the details of that site but I support unionization, for sure. If there are problems there, I want to know about them and I want to push Amazon to address them.

Okay, anyone else? Yes, Rich.

Question: So, Mr. Mayor, the President is going to give an Oval Office speech tonight in regard to the need for a wall. Do you plan to watch?

Mayor: Yes.

Question: And do you expect to be persuaded.

Mayor: No.

[Laughter]

Mayor: No. I mean, look at everything that we’re talking about here. The President should be focused on getting health care for all Americans. Instead, he’s tried to tear down the one piece of progress we have, which is Obamacare. And that $5 billion now, I hearing they may be talking about $7 billion for the wall. I can tell you – a lot of things we could do in this city to help people – rebuilding our infrastructure, help get people health care, improve our schools. That’s where that money should go to. The other thing that’s really pissing me off is that, this notion that, you know, we are the number-one terror target in the country. I have spent five years talking to Commissioner Bratton, Commissioner O’Neill, the FBI, the Joint Terrorism Task Force about the threats we face. I cannot remember a single conversation where they said there’s a threat to New York City coming from the southern border. This notion that terrorism is emanating from the southern border is laughable. We have some real challenges here that are not coming from the southern border. They are coming from other places – the airports are the place we need to be worried about, not the border wall. But also, if the President was serious about security, he would want to make sure that people on the terror watch list couldn’t get guns, but he hasn’t been too willing to take on the NRA. So, this is getting kind of stupid at this point.

Anyone else? Last call – once – I hear a voice – go ahead.

Question: Is there a plan to address floating advertising barges?

Mayor: I don’t like them and from the best of my understanding there is a real problem there, so I need to get briefed on that, but if, as I presume, they’re unauthorized, we’ll stop them.

Anybody else? David?

Question: Did you think your likeness on the Simpsons looked like you?

[Laughter]

Mayor: David – you and I have obviously found a very special connection point here.

[Laughter]

It’s my voice. I want to first say to the voice question because a bunch of people in my life have said that doesn’t look like you, that doesn’t sound like you. It is my voice. I don’t know what they did to it because it does sound kind of different, but it is my voice. Does it look like me – maybe in some idealized world, but –

[Laughter]

They missed the sideburns. I don’t use a sash. Mayor Quimby wears a sash, I don’t. Alright – last call.

Question: What’s up with that?

Mayor: So that was their thing. I was like, really? So yeah, it was basically a variation on the green giant, and I was kind of like – now that I’ve seen the whole thing, I’m like, do you guys ever put anything in context? And I love them, I think they’re like [inaudible] amazing show. But this image comes out of nowhere and then it’s gone and then there’s no reference. But I think because they are the Simpsons and they’re referencing all of American culture all of the time, that was a jolly green giant kind of thing. And when I taped it, I was in Midtown and I had the headphones on, and the producers were out in L.A., and they’re literally like – okay, we want you to try this, now we want you to try this. They’re like, can you do a green giant laugh – I’m like, something I do usually, but I can try.

[Laughter]

So, they just coasted through the get the thing they wanted. That’s my brush with fame.

[Laughter]

Question: [Inaudible] end up on the cutting room floor?

Mayor: No, they wanted to same thing over and over in different ways. So, that was literally what they taped. And you know, I was trying to understand – all they did say, Grandpa’s going to be on your shoulders. They said that Grandpa, for whatever reason he gets to come to New York City and he gets a lot of money – gets to come to New York City. They don’t explain why he ends up on my shoulders, but they wanted a combination of a height joke, and Grandpa’s on my shoulders, and I’m bragging about how far you can see from being on my shoulders, and it made sense at the time. I’m not sure it made sense in the flow of the show, but it was still just wonderful to be a part of it. I was very, very happy.